The Effect of Phenytoin on the Pharmacokinetics of Nevirapine and the Development of Nevirapine Resistance - Full Text View

Purpose

The primary objective of this two-phase trial is as follows:

To determine the elimination half-life of NVP in HIV positive pregnant women receiving it as a single dose in labour in addition to the ZDV and 3TC with or without seven days phenytoin (pilot PK phase)
To determine NVP resistance in HIV positive pregnant women receiving it as a single dose in labour in addition to ZDV and 3TC with or without seven days phenytoin (main trial phase)

The secondary objectives of this two-phase trial are as follows:

To determine the safety of single dose nevirapine with seven days phenytoin as a part of ARV prophylaxis for PMTCT vs. single dose of nevirapine without phenytoin as a part of ARV prophylaxis for PMTCT
To determine the HIV status of the infant
To determine the safety of the ARV prophylaxis for PMTCT with seven days of phenytoin on the newborn

Hypothesis: phenytoin reduces the elimination half life of SD NVP and thereby decreases development of resistance to NVP in HIV positive pregnant Tanzanian and Zambian women.

Condition	Intervention	Phase
HIV-infection Pregnancy Mother to Child Transmission	Drug: phenytoin	Phase 2


Study Type:	Interventional
Study Design:	Allocation: Randomized Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Prevention
Official Title:	The Effect of Phenytoin on the Pharmacokinetics of Nevirapine and the Development of Nevirapine Resistance After a Single Dose Nevirapine (VIramune®), Which is Part of ARV Prophylaxis for PMTCT in Moshi, TAnzania, and in Lusaka, Zambia (VITA2 Trial)

Resource links provided by NLM:

MedlinePlus related topics: HIV/AIDS

Drug Information available for: Phenytoin Phenytoin sodium Nevirapine

U.S. FDA Resources

Further study details as provided by Radboud University:

Primary Outcome Measures:

half-life time nevirapine [ Time Frame: untill two weeks after NVP dosing ]
blood samples will be taken <30 min after delivery, 24 hours after delivery, at day 3, at day 5, at day 7 and at day 14

Secondary Outcome Measures:

NVP resistance [ Time Frame: week 4 / week 6 after delivery ]
resistance testing at week 4 or week 6 after delivery (and NVP dosing).
safety of co-administration phenytoin and NVP [ Time Frame: entire trial ]
Adverse events will be collected during the entire trial (for both mother and child).
HIV status of the newborn [ Time Frame: week 6 after birth ]
HIV status of the newborn will be assessed at week 6 after birth.


Enrollment:	66
Study Start Date:	May 2010
Study Completion Date:	September 2012
Primary Completion Date:	June 2012 (Final data collection date for primary outcome measure)

Arms	Assigned Interventions
No Intervention: Control ARV prophylaxis for PMTCT follows national guidelines.
Experimental: phenytoin interaction ARV prophylaxis for PMTCT follows national guidelines + start phenytoin 184 mg (2 tablets of 92mg) OD at onset of labour and continue for seven days	Drug: phenytoin phenytoin 184 mg (2 tablets of 92mg) OD at onset of labour and continue for seven days

Detailed Description:

This trial (VITA2) will be done with phenytoin as enzyme inducer to decrease the elimination half-life of NVP as it has also shown a significant difference in the elimination half-life of NVP in the ENVI study and side effects were also transient and mild. The guidelines for ARV prophylaxis for PMTCT has been changed to a more complex regimen. Therefore addition of phenytoin OD for 7 days after delivery will not complicate the regimen for the mother.

Tanzania and Zambia are among the countries in sub-Saharan Africa most affected by the HIV pandemic. In 2008, an estimated 85,000 children were living with HIV in Zambia and out of the 89,000 children born to HIV infected women, 28,000 are infected annually. In Tanzania, 140,000 children were living with HIV in 2007. Both countries use NVP alone or in combination with other drugs as ARV prophylaxis for PMTCT. Little data are available on the extent of NVP resistance in the Tanzanian, Zambian PMTCT setting. Moreover, there is no data available on the follow-up of mother-infant pair with particular focus on resistance to NVP and the infants HIV status. No studies have explored possibilities of reducing NVP resistance by use of an enzyme inducer.

This study seeks to the effect of phenytoin on the pharmacokinetics of NVP and the development of NVP resistance on SD NVP as part of the ARV prophylaxis for PMTCT. This intervention will be part of the VITA2 trial to test the hypothesis that phenytoin reduces the elimination half life of SD NVP and thereby decreases development of resistance to NVP in HIV positive pregnant Tanzanian and Zambian women.

Eligibility


Ages Eligible for Study:	18 Years and older (Adult, Senior)
Sexes Eligible for Study:	Female
Accepts Healthy Volunteers:	No

Criteria

Inclusion Criteria:

HIV-infected as documented by positive HIV antibody test
Antiretroviral naïve
Starting ARV prophylaxis from 28th weeks of gestation or at least 4 weeks before delivery
Not intending to relocate out of the area for the duration of study participation
Willingness of subject to adhere to follow up schedule (note: this is more intensive for the pilot PK phase)
Ability and willingness of subject to give written consent
Pregnant women aged 18 years and above
Willing and able to regularly attend the antenatal clinic

Exclusion Criteria:

Serious illness that requires systemic treatment or hospitalization
Use of concomitant medication, which interferes with the ARV prophylaxis for PMTCT or phenytoin
Any condition that in the opinion of the investigator would compromise the subjects' ability to participate in the study
Previously treated for HIV infection with antiretroviral agents, including ARV prophylaxis for PMTCT
Inability to understand the nature and extent of the trial and the procedures required
CD4 count <350 cells/µl because such a patient is eligible for HAART

Contacts and Locations

Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its ClinicalTrials.gov identifier: NCT01187719

Locations


Tanzania
Kilimanjaro Christian Medical Centre
Moshi, Kilimanjaro region, Tanzania
Zambia
University Teaching Hospital
Lusaka, Zambia

Sponsors and Collaborators

Radboud University

Investigators


Principal Investigator:	Elton Kisanga, PharmD, PhD	Kilimanjaro Christian Medical Centre

More Information


Responsible Party:	Radboud University
ClinicalTrials.gov Identifier:	NCT01187719 History of Changes
Other Study ID Numbers:	UMCN-AKF 09.02
Study First Received:	August 23, 2010
Last Updated:	September 17, 2012

Keywords provided by Radboud University:


HIV pregnancy phenytoin ARV prophylaxis nevirapine

Additional relevant MeSH terms:


HIV Infections Lentivirus Infections Retroviridae Infections RNA Virus Infections Virus Diseases Sexually Transmitted Diseases, Viral Sexually Transmitted Diseases Immunologic Deficiency Syndromes Immune System Diseases Nevirapine Phenytoin Reverse Transcriptase Inhibitors Nucleic Acid Synthesis Inhibitors	Enzyme Inhibitors Molecular Mechanisms of Pharmacological Action Anti-Retroviral Agents Antiviral Agents Anti-Infective Agents Anti-HIV Agents Cytochrome P-450 CYP3A Inducers Cytochrome P-450 Enzyme Inducers Anticonvulsants Voltage-Gated Sodium Channel Blockers Sodium Channel Blockers Membrane Transport Modulators Cytochrome P-450 CYP1A2 Inducers

ClinicalTrials.gov processed this record on July 21, 2017

The Effect of Phenytoin on the Pharmacokinetics of Nevirapine and the Development of Nevirapine Resistance (VITA 2)